Sealant may help prevent misalignment of toric IOLs

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However, the smallest error or misalignment of the lens could cause refractive surprises, affecting positive outcomes and in some cases actually worsening the patient&rsquo;s vision.As a surgeon, it can be frustrating to perform a beautiful procedure, knowing with certainty the "><meta name="pageid" content="{58715D52-2B02-4E90-AB1F-E3F0601017EE}"><title> Sealant may help prevent misalignment of toric IOLs </title><link href="https://web.archive.org/web/20160618033503cs_/http://c1.wyanokecdn.com/bootstrap.min.css" rel="stylesheet" type="text/css"><link href="https://web.archive.org/web/20160618033503cs_/http://c1.wyanokecdn.com/social-buttons-3.min.css" rel="stylesheet" type="text/css"><link href="https://web.archive.org/web/20160618033503cs_/http://c2.wyanokecdn.com/healio-custom-responsive-styles.min.css" rel="stylesheet" type="text/css"><link href="https://web.archive.org/web/20160618033503cs_/http://maxcdn.bootstrapcdn.com/font-awesome/4.6.1/css/font-awesome.min.css" rel="stylesheet" type="text/css"><link href="https://web.archive.org/web/20160618033503cs_/http://c3.wyanokecdn.com/Healio_3_Nav_CSS/healio-3-navigation-styles.min.css" rel="stylesheet" type="text/css"><link href="https://web.archive.org/web/20160618033503cs_/http://c3.wyanokecdn.com/adviewability.min.css" rel="stylesheet" type="text/css"><meta name="viewport" content="width=device-width, initial-scale=1"><link rel="shortcut icon" type="image/x-icon" href="https://web.archive.org/web/20160618033503im_/http://i3.wyanokecdn.com/favicon.ico"><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://cdnjs.cloudflare.com/ajax/libs/json2/20110223/json2.min.js"></script><script>var ab=true;</script> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20160618033503js_/http://j2.wyanokecdn.com/adframe.min.js"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://cdnjs.cloudflare.com/ajax/libs/jquery/1.11.1/jquery.min.js"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://cdnjs.cloudflare.com/ajax/libs/jquery-migrate/1.2.1/jquery-migrate.min.js"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j1.wyanokecdn.com/jquery.isonscreen.1602291454.min.js"></script><script type="text/javascript">$j = $.noConflict();</script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j3.wyanokecdn.com/healiotwomobile.1606091255.min.js"></script><script type="text/javascript">(function() { try{var a={l1:document.location.host.replace(/^www\./,""),l2:document.title||"Untitled",l3:"__page__",l4:"-",sa:"",sn:""},b=[],c;for(c in a)b.push(c+"="+encodeURIComponent(a[c]));b=b.join("&");(new Image).src="//web.archive.org/web/20160618033503/http://d101gwbw02lzgk.cloudfront.net?a=397c6f988f4c431daea86384d4d0b1c3";var d=document.createElement("script");d.type="text/javascript";d.async=!0;var e=document.getElementsByTagName("script")[0];e.parentNode.insertBefore(d,e);d.src="https://web.archive.org/web/20160618033503/https://z.moatads.com/slackinc536aBcn79/moatcontent.js#"+b}catch(f){try{var g= "//web.archive.org/web/20160618033503/http://pixel.moatads.com/pixel.gif?e=24&d=data%3Adata%3Adata%3Adata&i=MOATCONTENTABSNIPPET1&ac=1&k="+encodeURIComponent(f)+"&j="+encodeURIComponent(document.referrer)+"&cs="+(new Date).getTime();(new Image).src=g}catch(h){}}; })();</script><script type="text/javascript" id="GoogleAnalytics"> if(!Array.prototype.indexOf){ Array.prototype.indexOf = function(obj, start) { for (var i = (start || 0), j = this.length; i < j; i++) { if (this[i] === obj) { return i; } } return -1; } } (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','//web.archive.org/web/20160618033503/http://www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-671605-73', 'auto'); if(window.ga){ ga('set', 'dimension8', 'None'); ga('set', 'dimension9', 'False'); ga('set', 'dimension11', 'NA'); ga('set', 'dimension12', 'ia_archiver'); if(typeof ab !== 'undefined'){ ga('set','dimension10', ab?'True':'False'); } ga('set', 'metric2', 5);} ga('send', 'pageview'); </script> <script type="text/javascript"> var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; // // (function () { var gads = document.createElement('script'); gads.async = true; gads.type = 'text/javascript'; var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 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"> 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patients who have a strong blink reflex. </div> <div class="byline"> <h6 class="doi"> </h6> <h6 class="date"> Ocular Surgery News U.S. Edition, June 25, 2016<br><i>Elizabeth Yeu, MD</i></h6> </div>  <ul class="module user-tools desktop-view" data-module="User Tools and Social" data-isroot="1"> <li id="main_0_maintwocolumnleft_0_ctl00_SocialTop_liComments" class="tools"><a href="/web/20160618033503/http://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7B58715d52-2b02-4e90-ab1f-e3f0601017ee%7D/sealant-may-help-prevent-misalignment-of-toric-iols/comments"><i class="fa fa-comment"></i> <span class="tool-text alt"> READ/SUBMIT COMMENTS</span></a></li> <li class="tools"><a href="https://web.archive.org/web/20160618033503/mailto:/?subject=I saw this article on Healio.com and thought you might be interested in it&Body="><i class="fa fa-envelope"></i><span class="tool-text"> EMAIL</span></a></li> <li class="tools"><a href="javascript:void(0)" onclick=" 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type="text/javascript"> if (typeof (savedoc) != "function") { function savedoc() { mustlogin(); } } </script>  <div class="wyContent"> <p>Toric IOLs present a significant advance in the correction of astigmatism and improvement of uncorrected visual acuity. However, the smallest error or misalignment of the lens could cause refractive surprises, affecting positive outcomes and in some cases actually worsening the patient’s vision.</p> <p>As a surgeon, it can be frustrating to perform a beautiful procedure, knowing with certainty the correct axis was identified and the lens placement was spot on during surgery, only to discover a surprise after the procedure. Not uncommonly, a misaligned IOL is the culprit despite correct initial placement.</p> <figure style="width: 96px;" class="mug pull-right"> <a href="https://web.archive.org/web/20160618033503/http://m4.wyanokecdn.com/dadcb6b8342e3bc47881799dc40b19c9.jpg"><img alt="" src="https://web.archive.org/web/20160618033503im_/http://m4.wyanokecdn.com/dadcb6b8342e3bc47881799dc40b19c9.jpg"></a> <figcaption>Elizabeth Yeu</figcaption> </figure> <h4>Possible causes of shifting IOLs</h4> <p>While rare, these misalignment occurrences could be caused by a number of dynamics. Some obvious risk factors include asymmetric or large diameter capsular bags, longer axial lengths, or a too large or decentered capsulorrhexis. These may cause rotation of the lens because the reduced area of contact between the rhexis edge and the optic could lead to a subtle destabilization of the optic during postoperative healing. Anterior chamber shallowing could also cause the optic to lose contact with the posterior capsule. To avoid this particular circumstance, I altered my surgical technique slightly. At the conclusion of cataract surgery, after all my wounds are sealed and watertight, I re-enter the anterior chamber with a 30-gauge cannula and tap down the IOL one more time to promote contact with the optic and adhesion.</p> <p>In my experience with the small series of patients in which rotation has occurred, those who are aligned with-the-rule or oblique seem to rotate more than the ones who are aligned against-the-rule. Additionally, excess viscoelastic behind the IOL could lead to potential issues with contact and the optic. Care should also be taken not to hyperinflate the eye. Hyperinflation, especially of a myopic eye, can lead to greater inflation of the bag and cause the lens to float and lose contact. If the eye is left hyperinflated, it is wise to ensure the optic is in contact with the capsule in order to mitigate any surprise.</p> <p>A particularly notable cause is when certain patients, especially intraoperatively, have a tendency to squeeze or blink strongly. If this occurs, it could cause a watertight wound to lose its seal. That strong squeeze or blink reflex could induce a “burp” of the wound or a subtle egress of aqueous out of the eye. This instability, coupled with the strong squeeze, could lead to the IOL moving out of position.</p> <h4>Ocular sealant for advanced technology IOLs</h4> <p>To combat the possibility of the lens misaligning, I now utilize ReSure Sealant (Ocular Therapeutix), specifically in those patients who are more at risk not only in toric lenses, but also in multifocal lenses because having perfect centration is invaluable for multifocal IOL results. A pliant hydrogel, this sealant is composed of polyethylene glycol, trilysine, buffering salts and more than 89% water. The ocular surface must be completely dry in order for the sealant to properly adhere. Application is quick and efficient, taking only seconds to administer, and it polymerizes into a pliant, synthetic hydrogel in less than 30 seconds. The FD&C Blue No. 1 element of the gel aids accurate placement and dissipates within hours, leaving a clear sealant on the eye that naturally dissolves. Clear corneal incisions commonly leak, whether hydrated or closed with sutures, and this egress can lead to subtle rotations and refractive surprises. This sealant has been shown to efficiently seal wounds, preventing even a strong lid squeeze from causing egress of fluid, thereby aiding in the prevention of IOL placement shifts.</p> <p>With so many possible factors that can lead to postoperative lens rotation out of a physician’s control, taking this small step to ensure a watertight wound seal is significantly beneficial in mitigating some of the risk. Even patients with a strong blink reflex can be assured the lens will remain sound. Because cost is a consideration, I particularly advocate the use of the sealant for all patients who are at a higher risk of displacing the lens, such as higher axial myopes or those I perceive perioperatively to have a stronger blink reflex.</p> <ul class="article-info-list"> <li class="h5">References:</li> <li>Chee SP. <em>Int Ophthalmol. </em>2005;doi:10.1007/s10792-007-9031-3.</li> <li>Herretes S, et al. <em>Am J Ophthalmol. </em>2005;doi:10.1016/j.ajo.2005.03.069.</li> <li>Masket S, et al. <em>J Cataract Refract Surg.</em> 2014;doi:10.1016/j.jcrs.2014.03.034.</li> <li>Mifflin MD, et al. <em>J Cataract Refract Surg. </em>2012;doi:10.1016/j.jcrs.2012.04.019.</li> </ul> <ul class="article-info-list"> <li class="h5">For more information:</li> <li>Elizabeth Yeu, MD, can be reached at Virginia Eye Consultants, Norfolk Office, Office & Surgery Center, 241 Corporate Blvd., Norfolk, VA 23502; email: <a href="https://web.archive.org/web/20160618033503/mailto:eyeulin@gmail.com">eyeulin@gmail.com</a>.</li> </ul> <p class="disclosure">Disclosure: Yeu reports she is a consultant for Alcon Surgical, Abbott Medical Optics, Bausch + Lomb and Ocular Therapeutix.</p> </div>  <div class="fig left"> <p class="figcaption"> </p> </div> <div class="wyPagination">   </div>         <ul class="module user-tools desktop-view" data-module="User Tools and Social" data-isroot="1"> <li id="main_0_maintwocolumnleft_0_ctl00_SocialBottom_liComments" class="tools"><a href="/web/20160618033503/http://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7B58715d52-2b02-4e90-ab1f-e3f0601017ee%7D/sealant-may-help-prevent-misalignment-of-toric-iols/comments"><i class="fa fa-comment"></i> <span class="tool-text alt"> READ/SUBMIT COMMENTS</span></a></li> <li class="tools"><a href="https://web.archive.org/web/20160618033503/mailto:/?subject=I saw this article on Healio.com and thought you 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</div> </div> </div>  <div class="copyright text-center"> <img width="69" height="21" alt="Healio.com" src="https://web.archive.org/web/20160618033503im_/http://i3.wyanokecdn.com/healio-logo-small.png"> <span>©2016 All Rights Reserved.</span> </div> </div>  <a href="https://web.archive.org/web/20160618033503/http://www.healio.com/pearlescentcabinet.aspx"></a> <div class="modal fade" id="dripmodal" style="display: none;"> <div class="modal-dialog"> <div class="modal-content"> <div class="modal-header"> <a class="close togclose" data-dismiss="modal"><span aria-hidden="true">×</span><span class="sr-only">Close</span></a> <h4 class="modal-title">Please Register</h4> </div> <div class="modal-body"> <div id="instructions" class="form-group" style="font-weight: bold;">In order to view this content, you must register below or <a href="#" onclick="showLoginForm();">log in</a>.</div> <div id="outputmessage" class="alert alert-danger" style="display: none;"></div> <div id="identifyform"> <div class="form-group"> <label class="col-md-3 control-label">First Name</label> <div class="col-md-9"> <input type="text" class="form-control" name="firstname" id="firstname"> </div> </div> <div class="form-group"> <label class="col-md-3 control-label">Last Name</label> <div class="col-md-9"> <input type="text" class="form-control" name="lastname" id="lastname"> </div> </div> <div class="form-group"> <label class="col-md-3 control-label">Email</label> <div class="col-md-9"> <input type="text" class="form-control" name="email" id="email"> </div> </div> <div class="form-group"> <div class="col-md-5 col-md-offset-3"> <input type="submit" class="btn btn-warning" id="dripcheck" value="Submit"> <img class="loading" style="display: none;" src="https://web.archive.org/web/20160618033503im_/http://i3.wyanokecdn.com/ajax-loader.gif" alt="Loading..."> </div> </div> </div> <div id="loginform" style="display: none;"> <div class="form-group"> <label class="col-md-3 control-label">Email</label> <div class="col-md-9"> <input type="text" class="form-control" name="username" id="username"> </div> </div> <div class="form-group"> <label class="col-md-3 control-label">Password</label> <div class="col-md-9"> <input type="password" class="form-control" name="password" id="password"> </div> </div> <div class="form-group"> <div class="col-md-9 col-md-offset-3"> <input type="submit" class="btn btn-warning" id="dologin" value="Login" style="float: none; left:0; top:0; position: relative;"> <img class="loading" style="display: none;" src="https://web.archive.org/web/20160618033503im_/http://i3.wyanokecdn.com/ajax-loader.gif" alt="Loading..."> <a href="#" onclick=" showForgotPasswordForm() ">Forgot Password?</a> </div> </div> </div> <div id="forgotpassword" style="display: none;"> <div class="form-group"> <label class="col-md-3 control-label">Email</label> <div class="col-md-9"> <input type="text" class="form-control" name="emailaddress" id="emailaddress"> </div> </div> <div class="form-group"> <div class="col-md-5 col-md-offset-3"> <button type="submit" class="btn btn-warning" id="sendpassword">Send</button> <img class="loading" style="display: none;" src="https://web.archive.org/web/20160618033503im_/http://i3.wyanokecdn.com/ajax-loader.gif" alt="Loading..."> </div> </div> <div class="form-group" style="font-weight: bold;"> In order to view this content, you must register below or <a href="#" onclick="showLoginForm();">log in</a>. </div> </div> </div> <div class="modal-footer togclose"> <a class="btn" data-dismiss="modal"><i class="fa fa-times"></i> Close</a> </div> </div>  </div>  </div>  <style>.form-group { overflow: hidden; }</style> <script>$j(document).ready(function() { $j('form').submit(function(ev) { if ($j('#dripmodal').is(':visible')) { ev.preventDefault(); if ($j('#loginform').is(':visible')) { doLogin(); return; } if ($j('#identifyform').is(':visible')) { checkDripReg(); return; } if ($j('#forgotpassword').is(':visible')) { forgotPassword(); return; } } }); $j('#dripmodal').on('hide.bs.modal', function() { $j("#identifyform").show(); $j("#loginform").hide(); $j("#forgotpassword").hide(); $j("#outputmessage").html(""); $j("#outputmessage").hide(); $j("#instructions").show(); $j("#instructions").html("In order to view this content, you must register below or <a href='#' onclick='showLoginForm();'>log in</a>."); $j('#dripmodal .modal-title').html("Please Register"); }); //rules $j('#identifyform') .bootstrapValidator({ feedbackIcons: { valid: null, invalid: null, validating: null }, fields: { firstname: { validators: { notEmpty: { message: 'Your first name is required' } } }, lastname: { validators: { notEmpty: { message: 'Your last name is required' } } }, email: { validators: { notEmpty: { message: 'Your email address is required' }, emailAddress: { message: 'Your email address is in an invalid format' } } } } }).on('success.field.bv', function(e, data) { var $parent = data.element.parents('.form-group'); $parent.removeClass('has-success'); $parent.find('.form-control-feedback[data-bv-icon-for="' + data.field + '"]').hide(); });; $j("#dripcheck").click(function(e) { e.preventDefault(); checkDripReg(); }); $j("#dologin").click(function(e) { e.preventDefault(); doLogin(); }); $j("#sendpassword").click(function(e) { e.preventDefault(); forgotPassword(); }); function checkDripReg() { var email = $j('#email').val(); var firstname = $j('#firstname').val(); var lastname = $j('#lastname').val(); if (!email || !firstname || !lastname) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } var jData = { "email": email, "fname": firstname, "lname": lastname, "source" : "Drip Registration" }; $j(".loading").show(); $j.ajax({ type: "POST", url: "/registrationapp/json/checkemailwithshortregacc", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); //$j("#outputmessage").text(response); if (obj.CheckEmailWithShortRegAccResult.AccountPreviouslyExist == true && obj.CheckEmailWithShortRegAccResult.EmailExist == false) { $j("#identifyform").hide(); $j('#dripmodal .modal-title').html("Please Login"); $j("#username").val(email); $j("#instructions").html('You already have an account with Healio.com. Please log in.'); $j("#instructions").show(); $j("#outputmessage").hide(); $j("#outputmessage").html(''); $j('#loginform').show(); $j('.loading').hide(); return; } else { //invalid email domain if (obj.CheckEmailWithShortRegAccResult.InvalidEmail == true) { $j("#outputmessage").show(); $j("#outputmessage").html('' + obj.CheckEmailWithShortRegAccResult.Message + ''); $j('#email').focus(); $j('.loading').hide(); return; } if (clickedLink != null && clickedLink != '') { // setting the cookie for those who came through the drip registration so they will able to step through all but post test step of activity (gamification) setCookie("edlabcmedripreg", obj.CheckEmailWithShortRegAccResult.UserId, 1); //$j('#dripmodal').modal('hide'); $j("#outputmessage").hide(); $j("#outputmessage").html(''); window.location.assign(clickedLink); return; } var location = "/footer/account-information/create-new-user" + obj.CheckEmailWithShortRegAccResult.Message + "&returnurl=" + window.location.pathname; window.location.assign(location); return; } }, error: function(jqXHR, textStatus, errorThrown) { //alert(textStatus + ": please make sure you fill in all fields."); $j('.loading').hide(); }, complete: function() { //$j("#outputmessage").html(""); //$j('.loading').hide(); } }); } function doLogin() { var username = $j("#username").val(); var password = $j("#password").val(); if (!username || !password) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } $j(".loading").show(); var jData = {}; jData.email = username; jData.password = password; $j.ajax({ type: "POST", url: "/registrationapp/json/login", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", dataType: "json", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); if (obj.LoginResult.Message == "Login Successful") { //$j("#outputmessage").html("<p>Welcome back. You may continue</p>"); // "Gourmand" cookies need to be set setCookie("edlabcmedriplogin", obj.LoginResult.UserId, ""); if (clickedLink != '') { window.location.assign(clickedLink); return; } else { location.reload(true); return; } //$j('#dripmodal').modal('hide'); } else { $j("#outputmessage").show(); $j("#outputmessage").html(obj.LoginResult.Message); $j('.loading').hide(); } }, error: function(jqXHR, textStatus, errorThrown) { alert(textStatus + ": please make sure you fill in all fields."); $j('.loading').hide(); }, complete: function() { //$j('.loading').hide(); } }); }; function forgotPassword() { var emailaddress = $j("#emailaddress").val(); if (!emailaddress) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } $j(".loading").show(); var jData = {}; jData.email = emailaddress; jData.website = "Healio"; jData.itemId = "{9FFB2568-23D5-47DA-85C9-C55E1EC8F4FF}"; jData.returnurl = window.location.pathname; $j.ajax({ type: "POST", url: "/registrationapp/json/forgetpassword", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", dataType: "json", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); if (obj.ForgetPasswordResult.EmailSent) { $j("#outputmessage").show(); $j("#instructions").hide(); $j("#outputmessage").html("An email has been sent to the email address provided. Please follow the instructions on how to reset your password."); $j("#forgotpassword").hide(); $j("#loginform").show(); $j("#password").val(""); $j('#dripmodal .modal-title').html("Please Login"); $j("#username").val(emailaddress); } else { $j("#outputmessage").show(); $j("#outputmessage").html(obj.ForgetPasswordResult.Message); } }, error: function(jqXHR, textStatus, errorThrown) { //alert(textStatus + ": please make sure you fill in all fields."); }, complete: function() { $j('.loading').hide(); } }); } }); function showLoginForm() { $j("#identifyform").hide(); $j('#dripmodal .modal-title').html("Please Login"); $j("#outputmessage").html(""); $j('#forgotpassword').hide(); //$j("#instructions").hide(); $j("#instructions").html("You already have an account with Healio.com. Please log in."); $j("#outputmessage").hide(); $j("#username").val($j("#email").val()); $j('#loginform').show(); } function showForgotPasswordForm() { $j('#loginform').hide(); $j('#forgotpassword').show(); $j("#instructions").show(); $j("#instructions").html("Enter your email address and we will send you a link to reset your password."); $j("#outputmessage").hide(); $j("#emailaddress").val($j("#username").val()); $j('#dripmodal .modal-title').html("Forgot Password"); } function showDripRegModal(href) { clickedLink = href; $j('#dripmodal').modal('show'); } function lockScreen() { //hide close buttons $j(".togclose").hide(); //disable background click dismiss $j('#dripmodal').modal({ backdrop: 'static', keyboard: false }); //disable scroll $j('html, body').css({ 'overflow': 'hidden', 'height': '100%' }); } $j("input[type='text'], input[type='password']").keypress(function (e) { if (e.keyCode == 13) { var thisid = this.id; if (thisid == 'username' || thisid == 'password') { $j('#dologin').trigger('click'); return; } if (thisid == 'firstname' || thisid == 'lastname' || thisid == 'email') { $j('#dripcheck').trigger('click'); return; } if (thisid == 'emailaddress') { $j('#sendpassword').trigger('click'); return; } }; }); var clickedLink = ''; function setCookie(name, value, days) { var expires; if (days) { var date = new Date(); date.setTime(date.getTime() + (days * 24 * 60 * 60 * 1000)); expires = "; expires=" + date.toGMTString(); } else { expires = ""; } document.cookie = escape(name) + "=" + escape(value) + expires + "; path=/"; } </script> <div class="ad-unit mblb mobile-view" data-module="AD Bottom Leaderboard Mobile" id="mobilebottomleaderboard"> </div> </div> </div> <div class="modal fade" id="modal" style="display: none;"> <div class="modal-dialog"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal"><span aria-hidden="true">×</span><span class="sr-only">Close</span></button> <h4 class="modal-title"> Notice</h4> </div> <div class="modal-body"> </div> <div class="modal-footer"> <button class="btn" data-dismiss="modal"><i class="fa fa-times"></i>Close</button> </div> </div> </div> </div> <input name="globaluserid" type="hidden" id="globaluserid" class="globaluserid" value=""> <input type="hidden" name="MediaFramework_ItemId" id="MediaFramework_ItemId" value="772958C5357F40FEB8C8B71D2B8DD728"> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="3AB62C6D"> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEdAATGI82XjVVtkfDN/j5egRfe3tcx1VRwu68RNCc/KE5ahXv9usr0ZhNsoPHKXLpb/p9PIo+FFjMupUV05XnSbW0puymAfUqKldUyYFlveyCpvSiBK4I="> </div></form><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j3.wyanokecdn.com/healiotwo.1602151030.min.js" defer="defer"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j3.wyanokecdn.com/bootstrap.min.js" defer="defer"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j3.wyanokecdn.com/adviewability.1604271059.min.js" defer="defer"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/http://j3.wyanokecdn.com/newmoduletracking.20151209.1.js" defer="defer"></script><script language="javascript" type="text/javascript" src="https://web.archive.org/web/20160618033503js_/https://cdnjs.cloudflare.com/ajax/libs/jStorage/0.4.12/jstorage.min.js" defer="defer"></script><script language="javascript" type="text/javascript" src="//web.archive.org/web/20160618033503js_/http://cdnjs.cloudflare.com/ajax/libs/jquery.bootstrapvalidator/0.5.1/js/bootstrapValidator.min.js" defer="defer"></script>  <script type="text/javascript"> //$j.nonCachedScript = function (url, options) { // options = $j.extend(options || {}, { // dataType: "script", // cache: false, // url: url // }); 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Sealant may help prevent misalignment of toric IOLs